Operating Room Management - Scheduling Operating Room Calendars

Scheduling Operating Room Calendars

Case scheduling or correctly selecting the day on which to do each elective case so as to best fill the allocated hours is most important, much more so than, for example, correcting errors in predicting how long elective or add-on cases would last, reducing variability in turnover or delays between cases, or day-to-day variation in hours of add-on cases.

Poor scheduling is often the cause of lost OR time. To more efficiently operate a surgical setting, managers may consider centralizing all scheduling to the operating room suite itself. Ideally, holding patient and surgeon preferences constant, an operating facility can identify cases and appropriately place them into predetermined time slots, or blocks.

To examine scheduling challenges, consider three possible surgical scenarios: elective (e.g. cosmetic procedures, stable situations not increasing in severity), imminent (e.g. inflamed gall bladder removal, potential for worsening harm if situations not surgically corrected,) and emergency surgeries (e.g. burst appendix, situations in which death or disability is possible or likely). The majority of operative time is a combination of elective and imminent surgeries. Albeit a smaller percentage, emergency surgical cases must always be handled promptly in order to ensure patient safety. Emergency surgeries are often unforeseeable and present a scheduling challenge as a result. Therefore, from a management perspective, one must use the elective and imminent surgical cases as a guideline for pre-determining operative schedules, while allowing flexibility for the emergency situations that indubitably arise.

The historical approach for scheduling operating room time is via analysis of previous surgical information. For example, to estimate how much time a cholecystectomy will require, the management determines how long previous cholecystectomy operations took the participating surgeon. Limiting this approach is the number of prior recorded cases and the surgeon’s familiarity with the procedure. Previously recorded information serves to set a precedent for turnover rates. By allowing surgeons to operate efficiently based on their previous timetables, a manager allows all parties involved to work more efficiently.

Nothing is more important than to first allocate the right amount of OR time to each service on each day of the week so that rarely do services fill their allocated OR time and have another case to schedule. This allocation is based on historical use by surgeon and then using computer to minimize ratio of underutilized time and over-utilized time (which is more expensive).

A prevailing school of thought is for managers to allocate operating room time based on the principles of safety, access and operating room efficiency, in respective order of importance. Part of a manager’s job is to clearly communicate these factors to all parties involved in care delivery.

There are times when a departmental manager must realize a departure from this practice and intervene to save profitability margins. For instance, an anesthesia practice group may negotiate extra funds from their employer (university, hospital, multi-specialty medical groups) to compensate for underutilized operating room time. In this instance, an anesthesia manager may use predetermined formulas to estimate excess labor costs they incur that are not offset by proper operating room utilization. A manager, whether departmental of administrative, that uses proactive applications can eliminate inefficiencies within their operating systems.